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The Factors That Affect Operating Room Start Time for Pediatric Femoral Shaft Fractures
Emi Schwab1, Shanika De Silva1,2, Kristin Livingston1,2
1Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts.
Insights
Delayed operating room start times for pediatric femoral fractures are linked to patient race, admission timing, comorbidities, and surgical approach. These delays increase hospital stays but do not impact immediate complications.
Area of Science:
- Pediatric Orthopedics
- Health Services Research
- Quality Improvement
Background:
- Operating room start time (ORST) for pediatric femoral fractures is a critical quality metric.
- Factors influencing ORST are not well understood, impacting hospital rankings and accreditation.
- This study investigates demographic and clinical factors associated with early (<18 hours) vs. delayed (≥18 hours) ORST.
Purpose of the Study:
- To identify demographic and clinical factors associated with delayed operating room start times for pediatric femoral fractures.
- To compare immediate postoperative outcomes between early and delayed ORST groups.
- To inform strategies for optimizing OR scheduling and improving patient care pathways.
Main Methods:
- Retrospective review of 216 pediatric patients with femoral shaft fractures (2021-2023).
- Analysis of demographic and clinical data to determine factors associated with ORST.
- Comparison of immediate postoperative outcomes based on ORST.
Main Results:
- Race, emergency department (ED) admission time, comorbidities, and surgery type significantly affected ORST.
- Patients from minority racial/ethnic groups had 2.4x higher odds of delayed ORST.
- ED admissions between 6 a.m. and 6 p.m. and patients with comorbidities or undergoing open reduction and internal fixation (ORIF) had significantly higher odds of delayed ORST.
- Delayed ORST was associated with longer hospital stays (71 vs. 41 hours) but not immediate complications.
Conclusions:
- ED admission time, race, comorbidities, and procedure type are key factors influencing ORST for pediatric femoral fractures.
- Longer ORST is disproportionately associated with extended hospital stays.
- Addressing these factors may improve OR efficiency and patient outcomes.
Background:
The operating room start time (ORST) for pediatric femoral fractures is a health-care quality metric used for hospital rankings and accreditation. Factors affecting ORST remain unclear. This study aimed to evaluate the demographic and clinical factors associated with gold-standard (early) ORST (<18 hours) versus delayed ORST (≥18 hours) for pediatric femoral fractures.
Methods:
A retrospective review was conducted of 216 pediatric patients with a femoral shaft fracture admitted to the emergency department (ED) at a pediatric Level-I trauma hospital from 2021 to 2023. Patient demographic and clinical data were analyzed to identify significant factors associated with ORST. Immediate postoperative outcomes were compared across ORST groups.
Results:
In multivariable models, race, ED admission time, comorbidities, and surgery type affected ORST (p < 0.05). Compared with White patients, patients of other racial or ethnic groups, including Hispanic, Black, Asian, and multiracial patients, had 2.4 times higher odds of delayed ORST. Compared with midnight to 6 a.m. ED admissions, the odds of delayed ORST were 6.6 times higher for ED admissions between 6 a.m. and noon and 9.2 times higher for ED admissions between noon and 6 p.m. Patients with comorbidities were 4.7 times more likely to experience delayed surgery compared with healthy patients. Patients who underwent open reduction and internal fixation (ORIF) were 2.5 times as likely as patients who underwent closed reduction (CR) with a spica cast to have delayed ORST. Delayed ORST was associated with longer hospital stay (median, 71 hours) compared with early ORST (median, 41 hours), but not with immediate complications.
Conclusions:
ED admission time, race, method of transfer, comorbidities, and procedure type were associated with ORST for pediatric femoral fractures. Longer ORST led to a disproportionately longer hospital stay.
Level Of Evidence:
Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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